改良前路病灶清除治疗下腰椎结核

目的探讨改良前路病灶清除植骨融合后路内固定治疗下腰椎结核的疗效。方法回顾性分析2005年4月起唐河县人民医院接受治疗的下腰椎结核患者8例。男3例,女5例;年龄2657岁,平均35岁。结核病灶累及部位:L₃～L₄1例,L₄～L₅4例,L₅～S₁1例,L₃～L₅1例,L₄～S₁1例。所有患者均行改良前路病灶清除植骨融合后路内固定手术并配合规范抗结核治疗。对患者术后症状改善、植骨融合及角度丢失等情况进行随访观察。结果所有患者随访624个月,平均14个月,其中4例获12个月以上随访,切口甲级愈合,术后全身症状及局部疼痛消失,无内固定松动。植骨融合依照Bridwell等评价标准:Ⅰ级2例,Ⅱ级2例。结论改良前路病灶清除治疗下腰椎治疗结核具有显露充分,病灶清除彻底,损伤相对较小的优点。

The treatment of modified anterior focus debridement for the lower lumbar tuberculosis

Objective To evaluate the curative effect of modified anterior focus debridement for the treatment of lower lumbar tuberculosis. Method Eight lower lumbar tuberculosis cases from April 2005 were analyzed retrospectively among whom 3 were male and 5 were female,and the age was ranged from 26 to 57 years with a mean of 35 years.For the focus of tuberculosis,1 was involved in L₃～L₄,4 were involved in L₄～L₅,1 was involved in L₅～S₁,1 was involved in L₃～L₅,and 1 was involved in L₄～S₁.All cases received modified anterior focus debridement,bone fusion and internal fixation along with strict anti-tuberculosis chemotherapy.The improvement of symptoms and neurological function,angles reduced by the surgeries and bone fusion during follow-up were observed. Result No recurrence was found in the follow-up period extending from 6 months to 24 months with an average of 14 months.4cases were observed for up 12 months,4cases acquired primary healing,the systematic and local symptoms were released postoperatively,and no internal loosing of the fixation was found.According to the standard of Bridwell,there were 2 cases in Bridwell class I and 2 cases in class Ⅱ. Conclusion The treatment of lower lumbar tuberculosis through modified anterior focus debridement has many advantages which include fully revealing,complete lesion resection,and less injury.